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Recurrent Miscarriage

Recurrent miscarriage (RM) is defined as more than three consecutive pregnancy losses. This affects one percent of couples trying to conceive. This is about three times more than you would expect to happen just by chance, so it seems that for some women there must be a specific reason for their losses. For others, however, no underlying problem can be identified; their repeated miscarriages may be due to chance alone.

 

How does the Recurrent Miscarriage Clinic work?

Couples are referred to the clinic by their GP, early pregnancy assessment unit or from other hospitals in the region.  In order to be referred to the clinic a woman must satisfy at least one of the following criteria:

  • Be under 35 years old and have had 3 consecutive miscarriages.
  • Be over 35 years old and have had 2 consecutive miscarriages.
  • Become pregnant as a result of IVF and have had 2 consecutive miscarriages.

Couples are first seen to arrange initial investigations.  The results of these investigations may take up to 8-10 weeks to come back.  At the follow-up appointment, an individualised care plan will then be made for all women.

 

What can be offered in recurrent miscarriage clinic?

(Please also see our information leaflet - link at the bottom of this page)

  • Supportive antenatal care

Women who receive supportive care from the beginning of a pregnancy have a better chance of a successful birth.  You will be offered fortnightly scans from 6 weeks to 10 weeks to closely monitor your pregnancy.  After 10 weeks, follow-up will be arranged in the dedicated RM Antenatal Clinic at Saint Mary's Hospital or at the antenatal clinic in your local hospital if this is more convenient for you.

  • Screening for abnormalities in the structure of your womb

A baseline ultrasound scan will be undertaken for all patients.

The following will be undertaken if there are further indications:

  • 3D scan
  • Out-patient hysteroscopy
  • MR (magnetic resonance) scan

Specialist uterine surgery can be arranged depending on the findings (eg, intrauterine adhesions (Ashermann's syndrome)/Uterine septum/Uterine fibroid.

 

Other tests/treatments that may be offered include:

  • Screening and treatment for Antiphospholipid antibodies (APA)
  • Screening and treatment for thrombophilias
  • Screening and treatment for vaginal infections
  • Tests and treatment for a weak cervix
  • Screening and treatment for underactive thyroid
  • Screening for Coeliac disease
  • Treatment with Vitamin D
  • Endometrial Scratch
  • Hormone treatment
  • Screening for abnormalities in the baby and placenta in consecutive miscarriages

 

The Multi-disciplinary links

The RM clinic has links with other clinics both at Saint Mary's Hospital and Manchester Royal Infirmary, meaning that couples have access to the best possible care.  These include:

  • Preterm Labour Clinic.

You may be referred here if your history suggests you have a weakness in your cervix.

  • Haematology Antenatal Clinic.

All women who are found to have thrombophilias or APA will have continued management throughout their pregnancy in the specialist antenatal clinic or the Recurrent Miscarriage Antenatal Clinic.

  • Genetics Clinic.

You may be referred here if karyotyping shows any abnormalities in the miscarried baby or placenta.

  • Endocrine Clinic.

Women with diabetes or thyroid problems may be jointly managed by this clinic.

  • Gastroenterology Clinic.

Women with positive test for Coeliac disease will be referred here.

The Multi-disciplinary team members

The RM service comprises a multi-disciplinary team of individuals who provide differing elements of input into your care, including:

  • A Consultant Gynaecologist who leads the RM Service
  • Consultant Obstetricians
  • Consultant Haematologist
  • Consultant Endocrinologist
  • Consultant Immunologist
  • Consultant Geneticist
  • Consultant Gastroenterologist
  • Specialist nurses from the RM Clinic and the Emergency Gynaecology Unit
  • Specialist Midwife from the Haematology clinic
  • Counsellor

Lead consultant for recurrent miscarriage service:

Dr Lamiya Mohiyiddeen

Consultant in Reproductive Medicine and Gynaecology

 

Location:

Gynaecology Out-patient Department, ground floor, Saint Mary's Hospital

 

Clinic times:

Monday                      9.00 am - 1.00 pm

 

Contact details:

Reproductive Medicine Admin team

Gynaecology Out-patients department

Telephone:  (0161) 276 6279/6358/6280

(Monday to Friday, 9.00 am - 4.30 pm)

 

Information Leaflets:

Additional Support:

www.miscarriageassociation.org.uk

http://www.earlypregnancy.org.uk